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Medication warnings
Certain veterinary medications for other conditions may seriously affect diabetic patients. This list is provided because some of these medications don't mention their side effects on diabetics in their literature. Many drugs used in veterinary medicine are also used in human medicine under a differently-trademarked name. Learning the human pharma name (if applicable) or generic name of the drug (same in veterinary & human medicine) can often give you additional information regarding possible side effects and how the drug may affect patients with diabetes. Human pharma drugs provide this information--for some reason, veterinary drugs don't always. If you are considering alternative or herbal medicine for your diabetic pet, see also Alternative medication warnings. Warning: Can Be Fatal to Diabetics and Non-Diabetics Contraindicated: May complicate or even promote diabetes Urinary Incontinence Proin, Cystolamine, Propalin, PPA-RD, phenylpropanolaminePhenylpropanolamine Information Sheet Precautions "Do not use in animals with glaucoma, enlarged prostate,' diabetes mellitus'Phenylpropanolamine Information Sheet, heart problems or high blood pressure." "Talk to your doctor if you have diabetes and you notice changes in blood glucose levels during therapy with acetaminophen/brompheniramine/'phenylpropanolamine'Health.com-phenylpropanolamine." "Because of its effects in elevating heart rate and blood pressure, phenylpropanolamine should not be used in patients with heart disease or pre-existing high blood pressure. This includes patients with glaucoma, hyperthyroidism, and diabetes mellitusVeterinary Partner Proin, Propalin, Phenylpropanolamine as well as those with certain types of cardiovascular disease." Hormones These types of hormones, when prescribed for diabetics, can be "double problems". The progestin-type hormones themselves, by natureProgestin-type Hormones--Natural Body Action, raise blood glucose; use of them can also mean the body may begin producing excess growth hormones, which causes insulin resistance. Antiarrhythmics/Heart/High Blood Pressure Steroids-Approach with caution *Oral or injected steroidsPetTalk.com-DexamethasonePetTalk.com-Triamcinolonesuch as cortisol are known to raise blood sugarMerck Veterinary Manual-Glucocorticoids and even sometimes cause diabetesChildrenwithdiabetes.com-Ask the D Team-2006. Talk to your vet -- sometimes steroids are still the best (or only) treatment for a condition and can be compensated for with known diabetes. Inhaled steroids for asthma may be tolerated by diabetics better than oral or injected. Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary Steroid Treatment and Insulin NeedsPetPlace.com-Insulin-Precautions & Side Effects. *MoreCorticosteroid Brand Name List brand names for corticosteroids are : *'Prednisone'PetTalk.com-Prednisone *'Decadron' *'Kenalog' One brand name for injectable prednisone (methylprednisolonePetTalk.com-Methylprednisolone) is Depo-MedrolDepo-Medrol Drug Information. There is another class of steroids in need of mention here. They are called anabolic steroids, and are related to the male sex hormone, testosteroneMayo Clinic-Anabolic Steroids. Their main uses are for medically supervised weight gainMayo Clinic-Anabolic Steroids, inappetance, (most commonly Winstrol/Stanozolol)Merck Veterinary Manual-Drugs Affecting Appetite, in treatment of some forms of anemia and cancerMayo Clinic-Anabolic Steroids. Many generic and brand name steroid medications, some with photo label links, are found on the Prescribed Steroids page. Warnings: May raise blood glucose levels Heartworm and flea/tick prevention *HeartwormPetTalk.com-DiethylcarbamazineMerck Veterinary Manual Antihelmintics-Miscellaneous Antihelmintics-DiethylcarbamazinePetTalk.com-IvermectinPetTalk.com-MilbemycinMerck Veterinary Manual-Heartworm Disease-MilbemycinMerck Veterinary Manual-Antihelmintics-Macrocyclic Lactones-Ivermectin and flea/tick prevention medications are known to produce temporary high blood glucose levels in some diabetic dogs. In the affected animals, glucose levels return to normal a few days after the medication is used--loss of control being temporary. Just as all diabetics are not troubled with post-prandial spikes or dawn phenomenon, not all diabetic pets react to these medications in this way. No pharmaceutical company's products of this type contain advisories regarding the temporary elevation of blood glucoseHeartworm Disease in Dogs: An Update (Prevension)-WSAVA 2005. Heartworm Prevalence of Heartworm WorldwideFeline Heartworm-WSAVA2003 is a global problem, with areas on all continents except Antarctica affected and is a disease that is far easier to prevent than to cure. It can affect both cats and dogsHeartworm Society-Dogs vs CatsHeartworm Society-Canine Heartworm DiseaseHeartworm Society Feline Heartworm DiseaseSouthpaws.com-Fall, 2000-Diagnosing Feline Heartworm. Should your pet be affected by this, a talk with your vet is in order. Increasing insulin doses to counter this temporary situation may cause hypoglycemia once the systemic medication level has lowered. The phenomenon also does not mean your pet has ceased to respond to the insulin you currently use. Since there are no formal label warnings, he/she needs to be aware that there are temporary side effects for these drugs which apply to some diabetics. *The same is true for flea and tick removal or prevention products, both professional and over the counter; they are also capable of producing this unwanted effect after use in some diabetic animals. Other Medications Epinephrine, or adrenalinPetTalk.com-Epinephrine, is a hormone present in all of us; most medical literature refers to it simply as the "fight or flight" hormone. It is what gives one that "extra boost" when needed to either escape danger or stand one's ground. A common medical use of epinephrine is to combat severe allergic/asthmatic reactions. Many people with life-threatening reactions to things like bee stings, etc., are never without their EpiPen. It's a pre-loaded injection of epinephrine to be used in an emergency. When someone with diabetes needs treatment with epinephrine, it counters the effects of the insulin and hyperglycemia is the resultEpinephrine/Adrenalin--Effect on DiabetesPetPlace.com-Insulin-Precautions & Side Effects. Also see below under diuretics/heart medications for some diuretics which can cause hyperglycemia. Warnings: May have other adverse side effects Antibiotics Our pets may be prescribed antibiotics for various reasons, such as a dental procedure or a urinary tract infection. *A common full-spectrum antibiotic given for dental procedures is ClavamoxClavamox-Petplace.com, which is available in both tabletClavamox Tablet Product Information and liquidClavamox Liquid Product Information form. The liquid form is sweet, but the sweetness is from an artificial sweetener and should not affect blood glucose. The pill can be crushed and added to wet food if the animal is difficult to pill. Some animals, like some humans, get diarrhea on antibiotics. This can be minimized by the concurrent administration of a probiotic like Culturelle Culturelle Information, which is available at vitamin stores. Consult with your veterinarian on the appropriate amount of probotic for your animal. Some caregivers report higher blood glucose levels while their pet is on antibiotics. *Another class of drugs used to fight various infections are called Sulfa DrugsPetTalk.com-SulfonamidesPetTalk.com-TrimethoprimPetTalk.com-Ormetoprim. They are often used similarly to antibiotics for this purpose. SulfaSulfa Drugs by Brand Name & Hypoglycemia drugs can cause hypoglycemia, even in those without diabetes. They are also capable of altering urine glucose test resultsMerck Veterinary Manual-Sulfonamides and Sulfonamide Combinations-Special Clinical Concerns. Diuretics/Heart Medications * Heart drug Digoxin and diuretic furosemide (both have many other brand names-table and links below), can interact with insulinDrugs Which Can Interact With Insulin. *Though its primary use is for treatment of diabetes, insulinUse of Insulin in Hyperkalemia Treatment is useful to both people and pets suffering from an overdose of potassium--too much of it in the blood. The medical term for this is hyperkalemiaPetPlace.com-Uses of Insulin. Potassium ions enter the cells through glucose--insulin helps bring this life-saving change about. *'Furosemide'/'frusemide' and other diuretics shown in table below, belong to a class of directics known as loop diureticsAction of Loop Diuretics and Common Brand Names for Them. This type of medication can cause hyperglycemia for those with diabetes. Both digoxin and furosemide/'frusemide' drain potassium from the system, along with the excess fluids they are prescribed to eliminate. Not all diuretics have this potassium-robbing action; those which don't are known as potassium-sparing diuretics. These drugs in combination with also necessary insulin can bring about a lower than normal potassium level known as hypokalemiaDigoxin & HypokalemiaPet Education.com-Drs. Foster & Smith-Potassium Deficiency & DiureticsRxEd.org-Hypokalemia. The problem can be prevented or solved by a prescription for a potassium supplement (K-Dur is just one brand name). *Hypertension drugs known generically as DiazoxideDiazoxide Drugs & Diabetes (Brand names: Hyperstat, Proglycem) are used not only for cases of high blood pressure, but also for treating non-diabetic hypoglycemia. This class of medication will raise blood glucose levels. *'Propanolol' AKA Inderal is a drug used to fight hypertension (high blood pressure) and heart disease in people. The drug belongs to the beta-blocker class. They work by blocking beta receptors in the heart for noradrenaline and adrenaline. Anyone with diabetes using beta-blockersBeta-Blocker-type Drugs & Diabetes needs to be especially careful, because they also can block some of the normal symptoms of hypoglycemia and may make a hypoglycemic episode last longer Beta-Blockers & Hypoglycemia. Beta blockers increase the risk of hyperglycemia in those with diabetes. *'Methyldopa'Methyldopa/Aldoril & Diabetes, brand name Aldoril, used in treating hypertension. can lower blood glucose levels. *'Verapamil' (Calan, Covera, Isoptin, Veralan) See Contraindications above for Antiarrthymics/Heart/High Blood Pressure. Causes hyperglycemia in dogs--can possibly precipitate a hyperglycemic crisis in canine diabetics. Antidepressants and Other Behavior-Modifying Drugs Many of the drugs commonly used for people are used for the same purposes in petsMerck Veterinary Manual-Psychotropic Agents. The following medications have been cited as having possible side effects in persons with diabetes: Warnings: Can Lower Blood Glucose *'Alcohol'Insulin Interactions with Other Drugs 7.6 can strengthen the blood glucose-lowering effects of insulin. Though our pets don't use alcohol as people do, there are medications and supplements both by prescription and OTC, which contain alcohol as part of their ingredientsBach Flower Therapy--WSAVA 2005. Reading labels carefully and being cautious when using meds containing alcohol can prevent possible hypos. *'Metoclopramide, aka Reglan, Clopra, Maxolon, Octamide, Reclomide' is used for GI problems and also to prevent vomiting. "Metoclopramide may accelerate food absorption and thereby alter insulin doses and/or timing of insulin effects.Metoclopramide elephantcare.org" For antibotics and sulfa drugs which lower blood glucose, see Antibiotics section above. All heart/hypertension/diuretics, some of which do lower blood glucose levels are also listed above in their own section. False Testing Results-Urine Glucose Some medications and supplements can cause false negative or false positive results when testing urine for glucose; see False Urine Glucose Testing Results for a list. If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. False Testing Results-Urine Ketones Some medications and supplements can cause false negative or false positive results when testing urine for ketones; see False Urine Ketone Testing Results for a list. If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. More Information *Multidrug Sensitivities in Dogs--How They Can Be Gene-Related *Commonly Used Veterinary Drugs and Dosages By Species *Therapeutic Drug Monitoring--Tailoring Drug Dosages to the Individual Patient *Start Page to US Pharmacopeia--Information on Over 9,000 Rx & OTC Drugs *AnimalHelp.com-Veterinary Drug Database *Avoiding Adverse Drug Reactions-WSAVA 2001 *Various Novo Insulins This pdf file contains some information about what medications may interfere with insulin treatment on page 2. *Drugs That Can Worsen Diabetes Control-Diabetes Self-Management-April 2009 References Category:Complications Category:Tips Category:Treatments Category:Content Category:Complications Category:Tips Category:Treatments Category:Content